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"Antiquated" hearing test

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It seems to me that the “beep” test is antiquated and not really very helpful. The audiologist wants you to indicate if you hear the “beep,” no matter how faint it might sound. However, a person (like me) who tries really hard will hear beeps from very faint to, perhaps, a normal volume. Since the audiologist is not asking whether the beep can be heard at a normal volume or is very faint, I think the test results are not very accurate. The results “over-state” the hearing in the case of very faint beeps. And just because I can hear a very faint beep doesn’t mean I could every understand words said at that volume and frequency. So, my hearing aids amplify sounds in the frequencies I can hear well to the point where those sounds “drown out” the sounds in the frequencies and volumes where I can barely hear. I think it would be better to indicate whether the beep can be heard easily or whether the beep is very, very faint. In other words, having 2 or 3 categories (such as very faint, moderately faint, and normal) might give a more accurate assessment of a person’s actual hearing capabilities. Does anyone else question this antiquated testing methodology?

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Throw in tinnitus and now you’re having real fun.

It was something I liked when I did my own insitu testing with all the software and gear. I was in control of when I could hear a particular tone. Down a notch…nope…up a notch…nope…up another notch…there it is…down again to make sure…nope…alright up a notch it is.

I agree though…I would wait to press the button until I was sure it was the tone I was hearing. Particularly the higher frequencies wit the tinnitus. But I don’t know how else they can somewhat objectively identify your hearing difficulties.

When I am in a sound proof room my tinnitus masks out almost all of the peeps. But as my Audi has said to me it is about all they have, he does a very long word test with me, I normally get at least 50 words for each ear. I have told my Audi that I never now if the beeps I hear is the test or just my tinnitus going nuts.

Add in the static from the ancient headsets that are around some aud departments, it’s nigh on impossible to hear the beeps. I think it’s been like this for decades and can’t see it changing anytime soon…

My last test warble tones were used instead of pure tones. I can see why it would help.

Edited

The beep test is looking for how soft a sound (the sound you can only hear 50% of the time) you can hear at a particular frequency. It is not looking for what sounds loud or moderate to you. It is not expecting that you can hear speech at that level. It is also relatively consistent from test to test.

Most modern prescriptive targets for hearing aids are based on these threshold measures, so to throw away the threshold testing would mean going backwards and re-doing a lot of stuff that has been worked out.

Patients always worry that their tinnitus is interfering and I’ll switch to pulsed tones to help, but I don’t generally find it to be the case. They may hit the button a lot more when a tone isn’t there (and goodness knows my tinnitus makes my very button-happy when I’m in the booth) , but the actual thresholds I record seem to be pretty stable from tests when their tinnitus is calm to when it’s loud.

@Deaf_piper said:

Add in the static from the ancient headsets that are around some aud departments, it’s nigh on impossible to hear the beeps.

THAT seems inappropriate to me. You’re sure the static isn’t a sound in your ears?

In reply to @Deaf_piper

headsets shouldn’t have any ‘static’ component at all - system noise and distortion are pretty well eliminated by proper calibration. If you’re detecting head-set noise, there’s a fault or there’s another signal/noise source in the room.

We use inserts for all testing here though as the coupling of headsets is never perfect IMHO.

Your are correct in saying you don’t listen at the softest place you can hear the beeps. The pure tones tell us the threshold of hearing at the different tones and you do not go through life listening at threshold. But what they do is give us a starting point for figuring a prescription for your type of loss. Take away the threshold measurements, and it would be pure guess work to develop a somewhat close prescription. So Yes, we don’t listen to the world at threshold, but we do need a starting point.

also, with my low frequency loss, sometimes I feel the vibration before I hear anything, and I have high pitched tinnitus, so I’ve had wildly varying test results.

In reply to @Neville

@Neville said:

It is also relatively consistent from test to test

I’m lucky in that about 8 years time (64 to 72) that I suffered little additional hearing loss. My pure beep tests 8 years apart are very consistent (I don’t have tinnitus). But just like if you want to perform your best at a sports event as a participant where you need to “get in your zone,” maybe patients at a hearing test need to warm up and focus (“mindfullness!”) to perform as best as possible. Maybe providers find that warmups and coaching really don’t make any difference. It’s all in the native ability of the patient or not. But maybe the right warmup, the right pep talk from the “coach” could actually help a patient enjoy and perform better in a beep testing, rather than wanting to say “beeping” things about the test?

Not enough data points in any direction. Are they graphing, what, 8 frequencies? We have 16 and 32 band hearing aids now so the test should be at least as accurate. I think at followup should be a freq sweep checking for equal loudness over the whole range, at a variety of volumes. You’d need a ton more time for the test but like an you don’t get useful data in just a few minutes.

I know I have put audiologists on the defensive with my post, but I stand by my criticism of the “beep” test. If all positive answers (i.e., affirmations of beeps) are used as the “baseline,” hearing ability is being grossly overstated because the faint beeps that are remotely heard (which would never translate into understandable speech) are being treated the same as beeps that are heard very well. Thus, if hearing aids are programmed using that information, sounds in the “easy to hear range” are going to be amplified to a greater extent than sounds that “were very faint and hardly heard,” resulting in the sounds in the “easy to hear range” drowning out the sounds “in the faint range.” I know I am not using the technical lingo (I am a lawyer and not an audiologist), but I have yet to hear an explanation from an audiologist regarding the efficacy of the “beep” test that I find convincing. And I am very frustrated that I cannot hear well nearly anywhere any more. When I go to meetings and conferences, I can hear the air coming through the vent extremely well and, in fact, so well that it drowns out the voices of the speakers. I don’t even care if I ever hear air coming out of the A/C vent.

As the slang goes, to understand “where you’re coming from,” it would help to post your as many of us have done (click on my avatar to see what I’m talking about).

We’re all individuals. What works for others may not work for you. But many people on this forum remark how well their ’s work for them. Obviously the beep test and the fitting algorithms worked pretty well for them. I think because something does not work well for one person doesn’t mean that it can’t work well for many, many other people (until something far better is invented - but you can’t just order it up like a pizza).

In reply to @karen1

That’s so true though Karen1. I once had three separate beep tests from three separate audiologists, with three crazy different results in the span of four months. ANY TIME I brought up the fact that my tinnitus was blocking the sound, or the fact that there were WICKED differences in tests, I was basically shushed, they’d blame it on eachother (or me) and I would leave feeling totally crushed because I know I can hear better than that, but they were adamant. (the one in my signature thing is the most accurate)

The Wikipedia article on Pure Tone Audiometry is pretty informative (may represent the view of one or a few individuals, though):

Pure-tone audiometry6

Pure-tone audiometry is the main hearing test used to identify hearing threshold levels of an individual, enabling determination of the degree, type and configuration of a hearing loss and thus providing a basis for diagnosis and management. Pure-tone audiometry is a subjective, behavioural measurement of a hearing threshold, as it relies on patient responses to pure tone stimuli. Therefore, pure-tone audiometry is only used on adults and children old enough to cooperate with the test p The curr...

In particular, the section on the nature of hearing disability vs hearing loss in terms of threshold detection, and talk of Factor A vs. Factor D:

Pure-tone audiometry2

Pure-tone audiometry is the main hearing test used to identify hearing threshold levels of an individual, enabling determination of the degree, type and configuration of a hearing loss and thus providing a basis for diagnosis and management. Pure-tone audiometry is a subjective, behavioural measurement of a hearing threshold, as it relies on patient responses to pure tone stimuli. Therefore, pure-tone audiometry is only used on adults and children old enough to cooperate with the test p The curr...

I think it’s basically saying besides loss of threshold tone sensitivity that one loses more complex sound discrimination, requiring sound you want to discern to be louder than noise, more so than for a normal person, and that the discrimination loss, the nature and its extent, is not measured by pure tone audiometry. This is probably not news to a lot of us on this forum.

The concluding lines of this section of the Pure Tone Audiometry article are pretty severe:

"…Thus, in noise the is irrelevant. It is the type of hearing loss that is important in this situation.[17]

These findings have important implications for the design of hearing aids. As hearing aids at present can compensate for Factor A, but this is not the case for Factor D. This could be why hearing aids are not satisfactory for a lot of people.[17] "

Seems like the folks who wrote the Wikipedia article had an axe to grind! (bad attempt at humor here!) @Karen1, 'fess up, - you wrote the Wikipedia article, didn’t you?!!

I’ve often thought that starting a particular tone at a clearly audible level then fading it out until inaudible would be useful.

As others have mentioned, the tones often stimulate tinnitus, which interferes with an accurate response.

Once a baseline is set by identifying the point at which the tone becomes inaudible, the volume can then fade low to high to provide a fair test.

Secondly, the warble tests aren’t that much better. I suggest that the beeps should be in changing patterns, perhaps using morse code. It would then be possible to identify truly if something is really being heard e.g. dit dit dah dit and so on.

I think that ,this problem was solved with Siemens and Resound as you can measure threshold level,the most hearing level , uncomfortable level and the conducting levels.
These 4 measurements will give you the most satisfying results.

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